对髋部骨折手术中低剂量脊髓麻醉对血流动力学影响的回顾性、观察性、单中心、队列数据库分析

BJA open Pub Date : 2024-02-17 DOI:10.1016/j.bjao.2024.100261

Stuart M. White

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引用次数: 0

摘要

背景脊髓（鞘内）或全身麻醉的慎重实施对髋部骨折手术后预后的影响可能比使用哪种方法本身更大。方法在这项观察性单中心研究中，分析了 280 名接受单侧髋部骨折手术的患者在使用高压脊髓布比卡因 0.结果97/98（99.0%）例患者的队列平均动脉压（MAP）在随后的 1 分钟记录时间间隔内保持在基线（脊髓注射）MAP 的 10% 以内。最低 MAP <70 mm Hg 和 <55 mm Hg 的发生率明显低于历史同等水平（麻醉实践冲刺审计 1 和 2）（分别为 52.9% 和 10.4% vs 71.9% 和 23.8%，均为 0.0001）。在 10 551 个 MAP 读数中，<70 mm Hg 和<55 mm Hg 的比例分别为 6.7% 和 0.4%。45名（16.1%）患者有相对持续的低血压（术中读数五次或五次以上，MAP≤70 mm Hg），与其余 "正常血压 "组群相比，他们在统计学上更可能体弱（诺丁汉髋部骨折评分≥7/10，37.8% vs 19.6%，P=0.0109）和服用α/β-受体阻滞剂（44.4% vs 24.3%，P=0.0099）。结论低剂量的高压脊髓0.5%布比卡因（1.3毫升，6.5毫克）在手术过程中对血压的降幅很小，并能提供足够的手术麻醉时间。现在需要对较低剂量与较高/标准剂量的脊髓麻醉进行随机比较，以确认对这一易受伤害的患者群体的疗效。

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A retrospective, observational, single-centre, cohort database analysis of the haemodynamic effects of low-dose spinal anaesthesia for hip fracture surgery

Background

Careful administration of either spinal (intrathecal) or general anaesthesia probably has a greater impact on outcomes after hip fracture surgery than which method is used per se. Intraoperative hypotension is associated with poorer outcomes, but appears less prevalent using lower doses of spinal anaesthesia.

Methods

In this observational single-centre study, intraoperative noninvasive blood pressure data were analysed from 280 patients undergoing unilateral hip fracture surgery after the administration of hyperbaric spinal bupivacaine 0.5%, 1.3 ml (0.65 mg).

Results

Mean cohort mean arterial pressure (MAP) remained within 10% of baseline (spinal injection) MAP for 97/98 (99.0%) subsequent aggregated 1-min recording intervals. The prevalences of lowest MAP <70 mm Hg and <55 mm Hg were significantly lower than historical equivalents (Anaesthesia Sprint Audit of Practice 1 and 2) (52.9% and 10.4% vs 71.9% and 23.8%, respectively, both <0.0001). The proportions of 10 551 MAP readings <70 mm Hg and <55 mm Hg were 6.7% and 0.4%, respectively. Forty-five (16.1%) patients had relatively persistent hypotension (MAP ≤70 mm Hg for five or more intraoperative readings), and were statistically more likely to be frail (Nottingham Hip Fracture Score ≥7/10, 37.8% vs 19.6%, P=0.0109) and be taking alpha-/beta-blockers (44.4% vs 24.3%, P=0.0099) than the remaining ‘normotensive’ cohort. Surgical anaesthesia remained effective for up to 190 min, with only one patient requiring supplemental local anaesthesia during skin closure.

Conclusions

Low doses of hyperbaric spinal 0.5% bupivacaine (1.3 ml, 6.5 mg) are associated with minimal reductions in blood pressure during surgery and provide adequate duration of surgical anaesthesia. Randomised comparisons of lower vs higher/standard doses of spinal anaesthesia are now required to confirm outcome benefits in this vulnerable patient group.